[00:00:00] Matthew Fullen: Pre Medicare law change, you just hear really heartbreaking stories about individuals who are starting to work with a counselor or a marriage and family therapist who then have to find someone else because As I They aged into Medicare or because they qualified for long term disability and then had to look elsewhere cases like that or cases where they wanted to work with a professional and nobody in their area was taking Medicare and it was a six month wait list before they could receive help.

[00:00:34] So we're excited to contribute to the broader mental health workforce that Medicare. now recognizes.

[00:00:43] Regina Koepp: you're going to let us in on some important information about Medicare billing for licensed professional counselors and LMFTs and other master's level licensed therapists. Dr. Matthew Fullen is an associate professor at Virginia Tech where he teaches in the counselor education program and serves as affiliate faculty for the Virginia Tech Center for Gerontology. Dr. Fullen's research, teaching, and advocacy focus on the mental health needs of older adults with an emphasis on addressing gaps in Medicare mental health policy and developing programs to enhance resilience and wellness and prevent suicide among older adults.

[00:01:23] He's the counseling profession's most active scholar on aging and mental health with over 40 peer reviewed publications and over 95 peer reviewed conference presentations and keynotes.

[00:01:34] Dr. Mary Chase Mize is an assistant professor of clinical mental health counseling at Agnes Scott College in Decatur, Georgia, a licensed professional counselor and an approved clinical supervisor and is certified in thanatology, death and dying and bereavement. She's earned her PhD in counselor education, an MS in clinical mental health counseling and MA in gerontology from Georgia State University.

[00:01:58] Dr. Mize manages Seek and Find Counseling and Consulting, a small private practice where she provides counseling services to older adults and individuals experiencing grief, bereavement, death anxiety, major life transitions, and suicide ideation and loss. She also serves as professional consultant and co author to the Keep Watch Project, an effort from the Episcopal Diocese of Atlanta to equip religious and spiritual communities with suicide prevention, intervention, and postvention response skills.

[00:02:29] Matt Fullen and Mary Chase Mize, thank you both for being here today. I'm delighted that you're here and you're going to let us in on some important information about Medicare billing for licensed professional counselors and LMFTs and other master's level licensed therapists.

[00:02:49] Regina Koepp: Mary Chase, will you give an overview of who professional counselors are and why it's important that LPCs, which is licensed professional counselor, and LMFTs, which is licensed marriage and family therapists, are now eligible to enroll as Medicare providers?

[00:03:07] Mary Chase Mize: Absolutely. Licensed professional counselors are a helping profession. We are trained to help individuals and their families and groups and folks achieve wellness. And our, there's a lot of similarities in, in, in work we talk about LPC, LMFT, LCSW, it gets like alphabet soup a little bit, and I would say that, providing psychotherapy, is a common ground and and certainly one that it's important that we know what these other specialties are doing and how they do it and also knowing, what's counseling, what does that look like?

[00:03:47] And we our training is very comparable to other types of helping professions like LCSW, like LMFT where we have Sequences of coursework. Our program is a 60 hour master's degree in, in mental health counseling and with a supervised clinical practicum sequence in that so that folks are then licensed eligible once they graduate and then actually practice.

[00:04:13] under supervision for additional years after completing their master's degrees to then achieve full licensure as a licensed professional counselor. And that's an overall look at what a counselor does. And I think another way of really talking about that is to talk about what my life looks like as a counselor and a lot of the kind of work that I do.

[00:04:32] And I have worked in a hospital setting. I was in an emergency room, And then short term inpatient stabilization unit, that was my first kind of clinical experience. And that involved doing assessments in the hospital for folks who might be having a mental health crisis. It also involved working alongside social work and other types of helping support to get folks safe upon discharge from the hospital and things like that.

[00:04:58] Coordinating care and counseling referrals and psychiatry referrals and All of that sort of work and then after that I worked in a community agency that was a mental health care agency, where the staff was a mix of folks who were licensed clinical social workers and licensed professional counselors, and we provided counseling services to the community, and that was where I first got involved with older adult counseling, and so my work there, I did my doctoral training there, And when I was doing my PhD, and I got to go to people's homes, to older adults homes who lived in different types of like senior housing HUD Section 8 housing, different sorts of areas there, some nursing homes, as well as assisted living care.

[00:05:42] And so I got to actually visit with older adults in their home, because sometimes that commute to the clinic, and this of course is pre COVID, before we realized how much we can do through telehealth, right? That was a really meaningful aspect of my work of going and talking and helping older adults achieve not just wellness goals, but also working through some substantial struggles that they're having in their life, different types of life transition.

[00:06:07] I worked with an older adult who had lived independently in the community for over 90 years. And then after an injury is now in a nursing home and so helping her and her family start to adjust to And so I wanted to show this change that has happened that is impacting, every aspect of how she sees herself and how she sees the days ahead for her and and then also saw folks in the clinic as well.

[00:06:32] And of course, after COVID started really expanding that telehealth access as well to older adults. And so now I have a small private practice where I work with folks. All through telehealth and especially older adults and I'm doing a lot of work with grief and bereavement. And the work of the counselor to go back to your original question is really bearing witness to and holding this kind of vulnerable, sacred space with people.

[00:07:00] As they navigate these challenges in their life, as they navigate distress that they may be experiencing from a mental health condition that we're, equipped to diagnose and work alongside to help provide treatment for. And also to have, room for those things that happen that can make life hard.

[00:07:18] And how to have someone provide that kind of safe therapeutic relationship and I think being able to hold that space with older adults is one of the most impactful and important things I think I'll probably ever do with my life.

[00:07:32] Regina Koepp: Beautiful. You both have alluded to as you're talking about yourselves and this work, Medicare.

[00:07:40] And Matt, I'm wondering if you could share a bit about what what some of the barriers are, were with Medicare billing related to LPCs and LMFTs, and then what the new changes are and what will LPCs and LMFTs have the opportunity to do with Medicare.

[00:07:58] Matthew Fullen: Absolutely. Yeah, so prior to the last few years the last time that Congress had updated mental health policy within Medicare was in 1989.

[00:08:10] And so in 1989, licensed clinical social workers were added as approved mental health providers and there were certain restrictions removed from the practice of psychologists at that time as well. So in 1989 the mental health needs of older adults were increasingly becoming known. We also knew at that point that there was this sort of projected demographic shift that we, would hear people alluding to.

[00:08:39] And yet, it hadn't quite emerged fully just yet. So fast forward 35 roughly years and you have older adults, that demographically have really increased dramatically with the boomer generation hitting 65 and just all of these demographic shifts that had been projected You know, we're now fully in the midst of that, we went through this global pandemic that we continue to navigate telehealth became, much more of a way to increase accessibility.

[00:09:10] So there are these number of shifts that had happened during that period of time. And yet. The last time the program itself had been updated continued to be, quite some time ago. In the midst of that there, there was ongoing legislative advocacy that many mental health groups, including groups that have an affiliation with professional counseling and marriage and family therapy, as well as broad Medicare advocacy groups.

[00:09:39] and consumer advocacy groups both those that really focus on older adulthood and aging, as well as those That focus more generally on mental health access there. There was this emergent coalition of advocacy groups that had been making, making these issues known to Congress over the better part of the last 15 to 20 years, but that really ramped up just in the last 5 years or so, as there was more.

[00:10:09] of a shared awareness that this was a bipartisan issue, that this was something that had a lot to get behind, a lot to there was, some degree of shared buy in around the growing mental health needs of Americans, and specifically the growing mental health needs of older Americans, and on top of that then, being able to highlight that this, Policy, the mental health provider policy was 30 plus years out of date, and during that period of time, the mental health workforce had really continued to evolve.

[00:10:44] And one of the things that is important to highlight is that when you look at sort of the macro landscape, there are Conservatively, 200, 000 licensed professional counselors, licensed marriage and family therapists not all of those individuals are independently licensed, they may be at different stages in the licensure journey, but that's 200, 000 plus professionals who have completed it.

[00:11:10] at least a master's degree, oftentimes in a 60 credit program, have had those supervised experiences that Mary Chase alluded to. And really what we had then was a mental health workforce that had been maybe unknowingly sidelined by the Medicare program. Nobody chose to draw it up that way. It was just the, the peculiarity of history.

[00:11:32] And so as that advocacy began to really pick up, And, I think there was more and more of that just shared buy in, again, bipartisan that this was something that would be very beneficial. We also saw, indicators in early 2023, so the Biden administration released its proposed budget and within that proposed budget within health care and mental health care was a recommendation to include professional counselors and marriage and family therapists.

[00:12:05] We also found that over the, over the years there was increasingly an understanding from the Center for Medicare and Medicaid services that there was a mental health workforce shortage and a misalignment between Medicaid and Medicare. That really needed to be looked at more closely.

[00:12:24] And so we saw some shifts in 2020, early parts of 2022 where CMS was making some recommendations about how we could use counselors and marriage family therapists more readily, but they also indicated we really can only go so far. Unless Congress changes Medicare law because of the way that statute is drawn up.

[00:12:46] So all that to say that in December of 2022, as part of the Consolidated Appropriations Act, which was the omnibus budget bill that Congress and the administration we're working on together within that proposed bill, was the language of the Mental Health Workforce Improvement Act, which, again, included licensed mental health counselors which is a Really just the different nomenclature, but the same thing as licensed professional counselors, as well as licensed marriage and family therapists that budget was passed and signed into law by President Biden at the end of 2022, with a projected start date of January 1, 2024. That new mental health provider regulation went into effect. And we're very early in this process but licensed professional counselors and licensed marriage and family therapists can now enroll in the Medicare program.

[00:13:46] And that enrollment process does take a little bit of time. There are some, hoops that are jumped through not unlike other forms of insurance.

[00:13:55] I'm now approved. I'm paneled by Medicare. And I can begin serving Medicare recipients as part of my practice. And we are seeing even though we're very early in this process, all of that hard work on the advocacy side really starting to bear fruit. And our expectation then is over the next several years.

[00:14:15] We will begin to see the saturation point among these new professions as they adapt internally to these new opportunities. So it is important to keep in mind that, licensed counselors and licensed marriage and family therapists trained to meet the needs of individuals who are, working through mental health conditions of all sorts.

[00:14:39] And some of these professionals have identified ways to serve older adults in spite of being excluded from the Medicare program up to this point. But there is some degree of catch up that will happen within our training programs, within downstream, as graduate students think about which profession Do I want to receive my training in those individuals who have more of an interest in older adulthood may be more inclined.

[00:15:07] To become counselors or marriage and family therapists than had previously been the case. And so it'll be really interesting to see how over the next few years, how that some of those dynamics play out. But the most exciting piece of all of this is that older adults and people with long term disabilities who rely on Medicare for mental health access will now have a better shot at finding a mental health professional in the communities where they live.

[00:15:34] Pre Medicare law change, you just hear really heartbreaking stories about individuals who are starting to work with a counselor or a marriage and family therapist who then have to find someone else because As I They aged into Medicare or because they qualified for long term disability and then had to look elsewhere cases like that or cases where they wanted to work with a professional and nobody in their area was taking Medicare and it was a six month wait list before they could receive help.

[00:16:08] So we're excited to contribute to the broader mental health workforce that Medicare. now recognizes. And to your question about what can counselors or marriage and family therapists do, it really is pretty equivalent across the board when it comes to what those professionals and licensed clinical social workers and to some degree what psychologists do as well.

[00:16:33] So anything that is in the talk therapy realm within the Medicare program, Is included and there are also increasingly efforts at the CMS level to try to provide a way to be reimbursed for adjacent therapies that might be a consultation with family that might be HBAI codes that are not necessarily fully focused on the mental health diagnosis, but some of the other health diagnoses that may be impacting their prognosis.

[00:17:04] And so it really is a pretty wide open book in terms of what the reimbursement itself can look like and which services Medicare recipients can receive from LPCs and LMFTs.

[00:17:16] Regina Koepp: Do LPCs and LMFTs need any specialized training to qualify for Medicare? So do they need any training above and beyond what they have with their license?

[00:17:27] Like a certificate in geriatric mental health or can they just apply based on their license?

[00:17:33] Matthew Fullen: Yeah, so the statute is written to allow anyone that is independently licensed in the state in which they practice is eligible. They do have to have either two years of supervised clinical experience, and that's very, broadly and that would be the prerequisite for independent licensure in those states anyway, in most cases.

[00:17:55] So either two years. Or 3, 000 hours of supervised experience. So there's no stipulation that they have to have unique training around working with older adults. However, my, my hope is that providers who enter in to the Medicare program will look for opportunities to not only use the skills that they already possess and try to apply those with a new population of individuals, but real, really early.

[00:18:24] look to opportunities to raise the bar when it comes to serving older people in particular. And that's where we're excited to partner with our peer professionals from psychology, social work, psychiatry Where there is a longer history of being able to work within the Medicare program and provide services to older people.

[00:18:47] And being able to find opportunities to collaborate around training and to really glean from other professions. How did you navigate this when you were first integrated into the program? How do you think about that from an individual provider standpoint? And then how do you think about that?

[00:19:06] From that macro professional standpoint, where we may need to look at accreditation standards in our training programs, or we may need to look at competencies that have not had the same need to be developed prior to this point.

[00:19:22] So there really is a, a lot of exciting opportunities to serve people through this program, but also ways that these professions will have to evolve themselves.

[00:19:31] Regina Koepp: Mary Chase, how do you see professional counselors complementing existing mental health care professionals in serving the needs of older adults?

[00:19:38] Absolutely. To echo what Matt said earlier, that there's, this one piece of it that over 200, 000 providers. Give or take now are eligible to fill in some gaps that may exist, whether that's from proximity to mental health providers, folks in more rural areas, things like that, where it's just the workforce just can't quite meet the needs. That older adults may have in terms of mental health care services and so that's, I see licensed professional counselors filling in some places to and I think this is true of most helping professions.

[00:20:17] Mary Chase Mize: There's this, there's a gap there. The Geriatric Health Care workforce needs to be bigger. We need more providers. We need more providers. In medicine and mental and behavioral health, across all these different disciplines. And so this feels like an amazing timing and opportunity to say, here's a, here's an entire profession that can now enter that geriatric workforce.

[00:20:42] And help support those, the, the things that we look ahead to 2040, 2050, 2060 and seeing how the United States is going to look a lot different in terms of age demographics. And that's one way of joining in. And, the other, the way that I see it I feel really lucky because I feel like I've had the opportunity to see this prior to, some of the official aspects of how this can be sustainable for a professional counselor.

[00:21:09] So I'll give you an example of that. When I did my PhD, I did a practicum and a doctoral practicum and internship at an agency that Focused on older adult counseling. And so I was able to do that because I was completing a practicum and internship sequence and while I was there, there was a job posting available for an older adult counselor.

[00:21:36] And even though I was doing that work, I couldn't apply for the job because I needed to take Medicare, right? So I had this I had this opportunity to work alongside social work, to work alongside psychiatry, to work alongside psychology I had that opportunity immersed in that. But it wasn't something that would be sustainable or even like replicable unless you were getting a PhD, right?

[00:21:57] Like it was in that kind of like narrow place. But while I was there I, gosh, it was incredible because oftentimes how I got connected to clients was often a result of case management. It was a result of like geriatric case management where they have these. Warm relationships with older adults who have case management for, any particular reason.

[00:22:22] And through knowing and understanding what's going on for that person having this oh we've got this counselor who might be able to, talk with you about this stress that you have around your relationship with your daughter now. Or to meet with you for some grief counseling after the loss of a spouse.

[00:22:39] or to help you navigate this, tumultuous relationship with your brother and, different types of things that are life and that, happen in life that through that kind of collaboration with the geriatric case management services, I got to step in and offer that service.

[00:22:56] And this was unique to the agency where I was because it was family and career services of Atlanta. And they have a very Wonderful Holocaust survivor support program. And so that was another way of through the, through this the survivor services for families, for individuals, there were a couple of instances that I got passed along as a potential referral for a particular need or struggle that someone may be experiencing that was known and passed along through that program.

[00:23:25] And so that was a way that was like, the agency was had all these moving pieces same with, with, they have a dental clinic as well. So way of helping provide dental care to folks across the lifespan, but also knowing, oh, there's this person who receives the service.

[00:23:40] Who's has, this struggle has expressed that they would like to talk to someone. where does that fit in and so I was able to just slip in and become that referral within those different networks of services that were provided and then and then working alongside folks who, there were some LCSWs who their role there was as a therapist, so their role was to do the talk therapy.

[00:24:06] There were other LCSWs there whose role was case management. Yeah. And getting to Enter in and immerse in some of those settings and I see that I feel very optimistic and I see that as something that it's just the beginning of how and what a counselor could look like in those settings and different doors that Medicare offers through that.

[00:24:26] I'm thinking like hospice. Hospice care and being able to complement existing services that may be provided through hospice, whether that's chaplaincy or social work or case management, things like that, being able to become another person who's part of that network of support to say, Hey I'm okay, but I'm worried about my daughter when this is all done.

[00:24:49] Would you be able to, refer to someone who I can talk with and things like that? Yeah, I think that answered the question, I hope it

[00:24:55] Regina Koepp: does. Yeah, I'm also hopeful I was providing a year and a half training kind of program to a community mental health agency. In Georgia, a couple of years ago, prior to this the passing of Medicare and I was doing a cultural humility training, not necessarily focused on older adults.

[00:25:12] And then I was like, y'all really need to get trained in working with older adults too. Can I provide a training to you? And the director, the clinical director was saying We, many of our clinicians, because most of our clinicians are LMFTs and LPCs, can't bill Medicare, so we're not seeing as many.

[00:25:27] We're referring out. And so my hope is that community mental health clinics who are very likely to take Medicare because they can get grants and SAMHSA grants, like all sorts of grants to do this will start to serve more older adults as well and my hope is that will improve access.

[00:25:46] Tremendously. I think that the hospice is a great area to and I'm just thinking about, in community mental health where we're serving so many people that older adults were left out because of the Medicare issue. And and I just am so grateful that this has passed because it's improving access.

[00:26:06] My big complaint though, is that Medicare maybe, Maybe Matt and your advocacy, you can ask Medicare to increase their repayment reimbursement rate because a lot of clinicians don't want to be on a Medicare panel because the reimbursement rate is so low, which is another barrier for therapists who have high student loans and older adults who need the Medicare, right?

[00:26:32] Matthew Fullen: Yeah, that particular issue is certainly one that pops up. And I think now that the number of people at the table has expanded so much it could very well be that the advocacy around things like reimbursement rates just we're stronger when we're all in it together.

[00:26:49] And to be able to impress upon congressional decision makers that this is also a barrier that gets in the way. And that leads to non participation in the program and things of that nature. I'm so glad you mentioned community mental health because In some ways that workforce infrastructure is already in place and as you mentioned is already accustomed to third party billing with Medicaid and Medicare in many cases and so it really could be as simple as just flipping that switch and say now our providers who we already are accustomed to working with.

[00:27:25] If we can enroll them in bulk and then do more targeted outreach to make sure that older people in our communities know that what we do here also belongs to them. And there may need to be a little bit of public relations work from those community mental health centers that had to, in some ways, turn that part of the population away for so long to now invite them back in and say, we're ready to serve you and we're ready to do that in a way that is culturally competent and can really meet the developmental needs that you have and so I think that's a really excellent point, and I hope they'll bring you in to do those trainings.

[00:28:03] They absolutely should.

[00:28:05] Regina Koepp: Yeah, I agree. Give me a call. All of you, community mental health agencies, I was thinking to there's a statistic by 2034, there will be more people 65 and older than children under the age of 18. I know for psychologists The last I looked, it was like 1. 2 percent of psychologists specialize with older adults, whereas something like close to 15 percent specialize with children.

[00:28:33] And so there is so much discrepancy, related to ageism, misconceptions about what's typical with aging and not, what misconceptions about what it's actually like to work with older people. I had a misconception about I used to think early in my career, I want to work with older adults, especially older adults at the end of life on hospice, but I don't want to work with people with dementia, and then I started working with, and I had a totally ableist approach and so I had to challenge myself to think more inclusively and relearn some of the messages I got about dementia and disability, and And then I learned to love working with individuals with dementia and families caring for loved ones with dementia and doing family systems work.

[00:29:16] The, there is so much ableism and ageism that influence my psychology, like psychology peers, mental health peers, medicine peers in doing this work. And I think the more conversations like we are having about how are we improving access from a policy perspective. So thanks for all of your advocacy.

[00:29:36] And now from a social perspective, like the gifts that come with working with older folks. And their families and people with disability, the gifts that come I guess

[00:29:47] I'm curious just to move from our head to our hearts a little bit about if you were going to share some of the gifts that you get from working with older adults What would you share?

[00:30:01] Like, how would, what would you say would be the most important part of doing this work from a soul kind of heart perspective?

[00:30:11] Mary Chase Mize: I love that question. And I'm sure I'll think of more things, but just off the bat I have so many moments with clients and I can definitely echo some of the I know I want to do this work, but there's this part of me that's who's going to listen to me?

[00:30:25] If I'm, a 30 something person. Working with someone who's in their eighties or, I had this self imposed I don't know enough to do anything like, that, that sort of thing. And I see that in my students. I see that as a kind of a hesitation that they may have.

[00:30:41] And I would certainly echo, ableism and ageism and these kinds of societal level isms that we're, we are encountering and we really see it show up in that kind of one on one interaction. But I've, I feel like one of the biggest gifts of working with older adults and from my experience of it is, it's this very shared experience of humanity, like you have this opportunity to sit with someone and, you have this kind of like a sacred space of I'm going to be with someone who's sharing their, the vulnerabilities of their life.

[00:31:17] And they're trusting me with this experience, this struggle, this, whatever it may be. And and then realizing that's age is so important. It's something that we all hope to one day share in, like becoming an older adult and it's this one aspect of, our identities that we might all one day share together and want to have, and that the, that aging is living.

[00:31:41] And so hearing that with my clients, it's like the con, the conceptions of what I might think. That would come up in a counseling session with an older adult. It's touching on my humanity. It's touching on my fears. It's touching on my anxieties. It's touching on, this kind of shared life experience and, seeing them as how lucky to live that way.

[00:32:06] this life, how lucky to be in a place where I'm, I've reached this age of where I saw my career go and what I did, with my life and work and what I'm continuing to do now, or what really matters to me after having, decades of, Things that I thought mattered.

[00:32:23] This is where this is what matters and it makes me feel like it. It's it changed is my perspective of what it is that I'm, investing my time into or my hope or fear or anxiety and to and it really is this I feel like it unlocks this level. of your humanity that you didn't know you had.

[00:32:44] Like it, it's like this way of caring for and being with another person that I do think is unique to that therapeutic relationship. But it's to me, it just feels like it's another level of being able to share that space with an older adult.

[00:33:01] Thank you.

[00:33:02] Matthew Fullen: I would just add that there's something about sitting across from someone who has been through life on all of the ups and downs of what life throws at you and being able to see and reflect in them and give voice to them the way that they have survived it.

[00:33:25] No matter what that what their story might consist of, like they are there and able to You know, to, to speak that back. There's something that is just very settling about that. Midlife has its fair share of anxieties and questions and what ifs and will I be enough and will I, do enough and what will my legacy be?

[00:33:48] And, all of these questions that sort of drive us to places of productivity and places of trying to. Make a name for ourselves and have careers and make enough money and not to diminish those sorts of midlife questions, but there's something about sitting across from people who have come through that, and who can in some ways speak to a place of they they've done it whether they feel like they've done it the way they wanted to or done it successfully, that may be the nature of what we're talking about in a session but they've made it, they've made it to that end point.

[00:34:25] And so there's something about that, that I think is a gift. For the therapist that is really hard to it's really hard to describe to someone else who hasn't had that gift. And so if I'm trying to relay the sort of the the opportunities of serving older people. To students who may not be as accustomed to that or have that interest, my, my desire is to convey to them like they're, we might talk this big game about, my, my clients teach me more than I teach my clients, but it is absolutely the case when you are working with older adult clients and there's this lack of, the trappings and errors and distractions of life that I think can be very refreshing and reorienting for me.

[00:35:16] And yeah it's always been just such a joy to work with people who are navigating some of those chapters.

[00:35:23] Mary Chase Mize: You just made me think about a client that I worked with who this was like early in my doctoral practicum, and we were talking about something, and I don't even remember what it was at the context, but she said it like flippantly, but she was like no one's going to be pulling a U Haul behind my hearse.

[00:35:38] With all my stuff in it and like the way she's when she's that was a moment for me and there will be moments where I'm still doing something or thinking about something and I hear her voice being like no one's gonna have a U Haul with your stuff and that like that's a you know a kind of a funny example of it but that was one of many types of things that I'm like wow this is I don't know that I would have that experience Working with someone my age. I don't know that someone my age would say that. Maybe they would.

[00:36:06] Regina Koepp: Seems more relevant. That's the later stage of life.

[00:36:10] I'm sitting here thinking about, I'm just listening to you two and I'm also thinking do a lot of psychotherapy and I practice from a relational perspective, and I think relationships are reciprocal.

[00:36:22] My patients don't know what they give to me, but they can feel that they give me something. And, I don't tell them all the, all of my inner workings and what they're giving to me. But I think they know and believe that the, What they're giving to me is equally rich and meaningful as what I'm offering to them in psychotherapy.

[00:36:43] And I think, to me, what's also so powerful about that is that this intergenerational experience so I'm approaching 50, and when I started working with older adults, I was in my 20s, and just to see, and many of my patients saw me pre, before I was married, and then when I got married, and then saw me pregnant, and then after I had kids.

[00:37:03] And and because I worked with my patients for a long time, like some 10, 12, somebody I work with now for 14 years and and he's seen me through so many iterations of my middle aged life and I think This experience of this intergenerational experience of both coming and approaching. We both have to address our own biases about the other person.

[00:37:30] We're both coming into the room, me with ageism, maybe them with internalized ageism, but them with questions like, is this younger person going to be able to help me through this life transition or whatever I'm dealing with? And that somehow we both have to do the work to meet to really see each other and back to that humanity piece that you're talking about, Mary Chase, I think is a really powerful ingredient in therapy, especially this intergenerational therapy.

[00:37:56] I think as a therapist, my boundaries don't have to be as firm with older adults because they're inherent boundaries in our, Because we're different generations, we're not peers. And where if I'm working with somebody closer to my own age, I have to be much more boundaried because there aren't as many inherent boundaries in our relationship.

[00:38:15] And that gives me a lot of freedom, like emotional freedom, which I really like in working with older folks and older families. I think there's so many gifts. to working with older adults. In fact, I just did a podcast, an episode about that five things older adults have taught me in working with them.

[00:38:32] And and I hope the lessons, and I'm sure the lessons, will just keep coming. Absolutely.

[00:38:38] Matthew Fullen: I think that's it's like have this secret when you've had the opportunity to work with older clients like you, through your experience, just how much you also receive from that.

[00:38:49] And I think there's a deep desire to for me to want my colleagues and my students and other people who have maybe not had that gift I want them to be able to experience it too. And sometimes trying to navigate that thick layer of ageism or ableism, or for the longest time, it was this policy that just created a barrier.

[00:39:19] I think when we speak with such exuberance about finally being at the table, it's not just some professional equity issue. It's not just some, Oh new markets to be able to, work with. It is a desire to be able to engage our peers in our profession in this incredibly satisfying work and to be able to offer whatever it is we have to offer as professionals.

[00:39:51] to the countless older people who would benefit from that sort of reciprocity, if only given the opportunity. So for me, like that's where it's at. We want to we want to participate. We want to learn from people like you, Regina, and others who have been doing this work for a long time.

[00:40:10] We want to be able to fully engage Because we believe that something beautiful will come from that. And we're just really excited to be to finally have that opportunity.

[00:40:22] Regina Koepp: I am so excited. I just think of how much needless suffering there is. And these misconceptions that older people, it's typical if you're depressed or anxious or have dementia.

[00:40:35] That then they're not getting services resulting in lots of suffering for the individual and the family and then the community and that by expanding access, we need professionals and we need to be working collaboratively and expanding services not reducing them.

[00:40:53] we need to wrap up. And as we do, let me just ask. how do people enroll in Medicare? Do they just Google, how do I enroll in Medicare?

[00:41:01] Matthew Fullen: CMS has that process laid out. And there is a, like a volume of applicants, of new applicants because of the new law going into effect, but it looks very similar to how people have enrolled in Medicare for a long time.

[00:41:14] And there should be similarities to enrolling in other third party payer systems. The opportunity is there and, again we envision that over months and years to come we'll see just this groundswell of professionals who are getting involved in this and hopefully that will continue to, yeah to make a difference in the opportunities that older people have.

[00:41:37] Regina Koepp: Thank you so much to the two of you for taking the time out of your busy lives and training. Because you're training emerging professionals and you have your own work and practices and efforts. I will be linking in the show notes to each of your websites so that folks can learn more about each of you.

[00:41:58] Do you have any parting words where people can find you, what you're hoping next steps are in the field? so much.

[00:42:05] ​

[00:42:05] Mary Chase Mize: Would say for me, I'm really excited about my role as a counselor educator right now. Because while, LPCs are absolutely positioned to start, enroll as Medicare providers, start working with older adult clients I feel like the work of graduating new clinicians to really dig into more of a gerontological specialty is really important and I'm really excited about that.

[00:42:35] And so I'm glad to be in this kind of role at my college of being able to provide that. That kind of gerontological lens to our existing curriculum. And I would say the timing of this is it's been unfortunate that it's taken this long for that legislation to be updated and for professional counselors, for counselor educators, this is really the, I feel like the start of something that could be really exciting and really meaningful and really important work.

[00:43:04] ​

[00:43:04] Matthew Fullen: Yeah, I would just add that, if a listener is looking for mental health care, those letters LPC or LMHC or LMFT those are the professions that we've been talking about.

[00:43:20] And it will take some time for that uptake to, for those professions to become fully enrolled. But if you're looking for services and you see someone with those letters, ask them if they take Medicare. If they say they don't, ask them why not. Ask them when they plan to do that. We want to put a little bit of the pressure on our own peer professionals to, to take that step.

[00:43:41] And if you're listening and you are a provider from a different background, I really genuinely want to look for ways to learn from what your professions have done for a much longer time, and I hope that LPCs and LMFTs that you might work alongside in your agencies will take advantage of that as well and try to learn from you and what you have to offer.

[00:44:05] And if you happen to be an LPC or an LMFT listening to this, go enroll today. Go find out more about what comes next. This is really an amazing opportunity to serve older people. And so I've just, like I alluded to earlier, I just really want people to do this work because it's such meaningful work.

[00:44:25] And it's so important to the older people in our communities.

[00:44:29] Regina Koepp: And to our own future selves.

[00:44:32] Matthew Fullen: Absolutely.

[00:44:32] Regina Koepp: Absolutely. Thank you so much to the two of you. I really appreciate your time and contribution today. Thank you.